A Critical Look at California’s Bill SB 277

This week California passed bill SB 277, removing the religious and personal exemptions for vaccine refusal for children attending public schools and daycares.  The bill is set to strengthen current laws on the books that say students must be fully immunized to enter schools by removing non-medical exemptions and extending it downward to other social areas for children, like daycares.  As someone who believes in vaccines and would like to see better education and information out there for parents to make their decisions on (you can read up on my Vaccine Education Resource Link here where I outline what I find to be great, science-based resources for parents), I cannot and will not ever support a bill like SB 277.

Supporters of the bill believe it will increase waning vaccination rates in California and help keep other children who are immune-compromised from being put at risk by non- and under-vaccinated children.  I understand that goal, I just happen to think that this is exactly the wrong thing to do and doesn’t actually address some of the issues that California faces when it comes to vaccines.  I’ll outline below the main problems I have with this bill in hopes that people can see that bills such as this ignore systemic issues and place undue burden on families that don’t deserve it and fail to help solve any of the problems it claims to address.

Problem #1: It Removes Parental Choice for Medical Decisions

Supporters of the bill frame it in terms of public health concerns, yet we are talking about medical decisions with risks.  There are extreme circumstances where families have had their medical decision-making power rightfully taken away from them when they show gross neglect for their child’s well-being, but this is not that case.  The fact remains that vaccination – though incredibly safe on a population level – includes risks.  As of right now, we don’t actually know all the children that will react negatively to vaccines and this is research that must be undertaken to help families who are being swayed by fear away from vaccines to realize their general safety and to make it more applicable to their  situation.

Some individuals have tried to argue that this is comparable to current laws on car-seats or seat belts, which are mandated, yet this presupposes there is no risk to vaccination which isn’t true.  Part of the reason families get to choose the medical procedures their children are exposed to is because they are the ones who are closest to and have to live with the accepted risk.  With car seats, there is no risk, it’s a situation in which the child wins because there is greater safety with zero risk.  Furthermore, driving is not an inherent right (as is education, which I’ll get to) meaning a family who really has a problem with car seats can get around just fine with no impediment to their other rights.

 
One of the other issues that comes up here is that medical exemptions remain.  However, there is no standardization as to the applicability of a medical exemption.  The CDC guidelines only speak of exemptions when the individual child’s life is known to be at risk; however, the decision lies with each individual doctor.  Some will take family histories of various diseases and reactions by siblings into account, some will not.  Some will take known allergies into account, some won’t.  Depending on your doctor or your ability to meet with multiple doctors, you may or may not receive a needed or not-needed medical exemption.  This lack of standards (and frankly, knowledge about who should receive a medical exemption as we haven’t done the research needed to identify all of those children most at-risk) means parents are left in a no-man’s land and although the safety of vaccines at a societal level shouldn’t be in doubt, at an individual level, there are valid questions each family must ask and try to answer.

Regardless of my view of the safety of vaccines, medical decisions have been traditionally left in the hands of parents because the idea that a government can decide what risk you have to be comfortable with is, frankly, asinine.  The idea that this is being taken away is rather disturbing.  Now, people have pointed out – rightfully – that this isn’t really being fully taken away because families who choose not to fully vaccinate (no skipping or delaying anything) can simply keep their kids home and educate them there.

Problem #2: Using Education as the “Consequence” Violates Children’s Rights to Education

There are lots of problems with the current education system and as someone who will be homeschooling my daughter, I certainly see that.  However, children’s education is mandated in the United States.  That is, children have a right to a certain level of education and the goal of this mandate is that the children have the education and knowledge needed to become functional members of society.  This right is not dependent upon family wealth, race, sex, or any other factor as it is an inherent right of children.  It is also not a right of their parents, but of the child him/herself.

What does this bill do?  It puts this at-risk for some children.  Although I clearly believe that families can homeschool brilliantly, not all families can or will.  Not all families want to and their beliefs on certain medical issues should not mean their child is no longer afforded the right to a public education.  This violates the inherent premise of public education and should not stand.  This does not mean the children should have the right to attend whichever school they want, but that the only options being to find an independent school that will accept them or to homeschool is not okay.  I would actually be okay with one school per district being open to families who have opted not to vaccinate and leaving the remaining schools closed to full-vaccination provided things like bus services were available to take children to a school in their district.  The tax money that goes towards education goes towards the education of all our children (unless families choose to opt-out in favour of another education plan, based on educational reasons) and should not be dependent upon accepting government-mandated risks on the health of our children.

Education being what it is, it already disproportionately favouring the wealthy in the USA with better schools in wealthier school districts.  This bill, if fully implemented, manages to also affect the education of the poor more than that of the wealthy and this brings me to problem #3.

Problem #3: It Primarily Affects the Poor

The wealth needed to keep kids home is not possible for every family nor is the desire or ability to properly homeschool.  This bill then disproportionately affects these families who are not able to homeschool or afford independent schools.  Families with a good-enough income are able to continue to opt-out of vaccines and keep their children out of public or licensed facilities (in the case of daycares).  For families with a higher income who want their children in these facilities, they will likely to be able to have the time and resources to find a doctor willing to sign a medical exemption or falsify vaccination reports for a fee (yes, this already happens, so don’t look shocked) whereas a poor family cannot.

Although wealthier areas are those with the highest rates of personal belief exemptions when entering schools, poorer families and areas have a preponderance of under-vaccinated children.  That is, they have children who have some, but not all, vaccines and would still be punished under SB-277 (as it requires full compliance with the current vaccination schedules).  If enforced strictly, families where parents are working multiple jobs or are unable to provide the type of quality education at home will suffer.  As mentioned in Problem #2, children have a right to a certain level of education that not all families can afford to give their children themselves.  Poorer families will be more likely to be in this group due to working multiple jobs and/or not having the resources to do this up-to standards.

As poorer families already face greater scrutiny from agencies like CPS (Child Protective Services), this is one more way in which they are vilified and face additional rights being stripped away due to poverty that the wealthier families do not (including removal of the child if educational standards are not up to par).  Again, one can say they should just vaccinate then, but this first ignores that this “choice” isn’t a real choice for them yet remains a “choice” for wealthier families, creating greater inequality.  Second, it ignores that the bill does nothing to address why these poorer families have greater rates of under-vaccination, which is really a part of my last and perhaps most important problem with this bill.

Problem #4: It Doesn’t Actually Address the Main Vaccination Problems in California

When it comes down to it, this is possibly the biggest problem because the bill creates the illusion of helping vaccination rates while doing nothing to actually address the problem.  Let’s return to the under-vaccination issue of the poor.  According to California data reported on earlier this year, non-vaccination affects 2.54% of children, but under-vaccination affects 6.86%.  As mentioned, non-vaccination is predominantly found in wealthier areas meaning these are the families that are least likely to be affected by this bill, but the under-vaccinated?  They are found in the lower-income areas of the State.  They are also clustered, just like non-vaccinated families, with some schools reporting that 80-90% of children are under-vaccinated.  Yes, that is not a typo, 80-90% of kids are not up-to-date on their vaccine schedule.

The problem?  These aren’t families seeking an exemption.  These are families who have systemic barriers to vaccination like ability to get to clinics due to travel problems or even making it to open clinics because their work schedules don’t allow them to go to clinics or lack of family doctors.  This are problems facing the poor, the group that, if implemented fully, will be most affected by this bill despite not actually being “anti-vaccination”.  They will be punished for something they would be willing to do if the State actually had a system set up that allowed them to do it.  The bill includes nothing that will help alleviate this problem for families, only punish those who can’t comply, but couldn’t comply earlier.  Where’s the bill proposing vaccination clinics in schools or daycares for families to opt-in to?  Or traveling clinics that go to areas of the state most affected by under-vaccination?  Or removal of even the smallest of co-pays that may be prohibitive for some families?  If our politicians actually cared about vaccination instead of putting on a show, these are the types of bills you’d see put in before trying to take away the education rights of children and the parental rights of parents.

It’s not just this, though, as the bill also does nothing to offer more education to those wealthier families who choose to opt-out.  Although there is a misconception about the types of families who opt-out of vaccines (namely that they only use google research, subscribe to quack theories, and so on, none of which holds true in research about these families as they are educated and do far more research than the average person on vaccines), there are misconceptions about science in our society that make vaccines more likely to be seen as problematic by educated individuals.

You see, the more you learn, the more you also learn about all the flaws in research, the caveats that are part of the research, and so on.  With this knowledge comes the realization that we know less than we think.  As I continued on in my post-graduate degrees, there was often talk about the stages individuals go through with respect to knowledge: With a bit of knowledge, one is certain issues are black and white and we think we have the answers, but as our knowledge grows, so does the awareness that nothing is that clear cut.  The same rationale applies to knowledge about vaccines.  When I hear people say the science is “unequivocal” or there are no questions left to answer, I shake my head because that’s not true at all.  Even if I agree with them on the importance of vaccines, in no way do I believe the issue is cut and dry or black and white.  Not at all.

However, there’s a big difference between acknowledging the holes in the research and saying the research is invalid.  What hasn’t happened thus far in the vaccine discussion is an acknowledgement that there are unanswered questions, the research on an individual level isn’t conclusive (though is on a population level – akin to some of the difficulties in talking about breastfeeding versus formula use for a given family versus at a policy level), and that a one-size-fits-all solution isn’t a solution at all.  With the refusal to acknowledge these things, it is nearly impossible to reach those who, because they have added more knowledge than what is traditionally shared, aren’t certain about the choice to vaccinate.

Real discourse involves acknowledging the questions and concerns families have and talking to them about it.  Bill SB 277 offers nothing of the sort and as the families that tend to choose a personal belief exemption are wealthier and may not need to worry about any of consequences built into this bill, there is no way to sit down and discuss their concerns and possibly change some minds.  It’s treating the issue as if the only way to reach people is to coerce them while knowing full-well that they may not be coerced at all.  When you combine the lack of discussion and further education with the failure to provide for those who are under-vaccinated, it becomes pretty clear (to me, at least) that this bill does nothing to help actually increase vaccination rates and help the immune-compromised it’s claiming to help.

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Taken together, these problems mean I can’t see bill SB 277 as positive at all.  It is a “feel-good” bill for those who fear the non-vaccinated, but actually doesn’t address the problems and issues that have lead to non- and under-vaccination in the state.  There’s no room for further education and no room for fixing the systemic problems that plague many low-income families.  You want higher vaccination rates?  Offer better education programs that really include talking to families about their concerns instead of shutting them out and calling them names.  Spend some of the health care money on a public vaccination program that would enable families to easily access vaccines at schools or daycares so lower income families don’t face the problems they do trying to do what they don’t have an objection to.   Work on and develop alternate schedules that are acceptable to those involved in public health because the fact that there are discrepancies between the USA and other countries tells people something is off about the idea that only one schedule will work.

Will you have 100% vaccination rates?  No, but that’s okay because you’d be doing better than what’s going on today.  Figure out what the real goal is and then work towards it in ways that make people want to work with you.  It really is that simple.